Provider Demographics
NPI:1689057911
Name:PROMOTION PHYSICAL THERAPY AND REHABILITATION, LLC
Entity Type:Organization
Organization Name:PROMOTION PHYSICAL THERAPY AND REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:706-454-2000
Mailing Address - Street 1:1001 VILLAGE PARK DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-5101
Mailing Address - Country:US
Mailing Address - Phone:706-454-2000
Mailing Address - Fax:706-454-0806
Practice Address - Street 1:1001 VILLAGE PARK DR
Practice Address - Street 2:SUITE 105
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-5101
Practice Address - Country:US
Practice Address - Phone:706-454-2000
Practice Address - Fax:706-454-0806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-06
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6989261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBBQBMedicare UPIN